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General NPI Number Information
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NPI Number | 1346835824
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Entity Type | Organization
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Legal Business Name | VENISTAT MOBILE PHLEBOTOMY LLC
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Dates
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Enumeration Date | 03/05/2021
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Last Update Date | 03/05/2021
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Provider Practice Location Address
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Address Line | 221 OUTER BELLE RD APT A
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City | DAYTON
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State | OH
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Zip | 45426-1538
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Country | US
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Telephone | 937-307-9639
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Fax | 937-715-4049
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Provider Business Mailing Address
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Address Line | 221 OUTER BELLE RD APT A
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City | DAYTON
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State | OH
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Zip | 45426-1538
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Country | US
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Telephone | 937-307-9639
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Fax | 937-715-4049
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Authorized Official
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Title or Position | OWNER
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Name | MS. ANDREA M PHELPS
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Credential | CPT
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Telephone | 937-307-9639
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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